4. Clinical Guidelines for Liver Transplantation (PDF) - British ...

Guidebook for the Solid Organ Transplant Programme Chapter 4
4.3.1 IN-HOSPITAL CARE
4.3 Post-Transplant
After the transplant operation, the patient is transferred to the Intensive Care Unit (ICU).
Management in the ICU specifically relates to the identification of early post-transplant
complications such as bleeding, metabolic abnormalities, perfusion abnormalities, ventilatory
support and sepsis. The patient is carefully monitored with tests, hemodynamic monitoring and
clinical examination. Most patients will spend 24 to 48 hours in the ICU before being
transferred to the Transplant Unit. Occasionally, patients with serious complications or
respiratory problems may have a more prolonged ICU stay.
(See Appendix C: Liver Transplant Post-operative Orders in ICU)
From the ICU, the patient will be transferred to the transplant unit. Postoperative care of the
patient involves standard surgical nursing care, nutritional support, mobilization, medical and
immunosuppressive therapy, monitoring for rejection, sepsis, or biliary tract complications and
education for the patient and his/her family. Psychological interventions are available to assist
the patient in coping with inevitable stresses and for anxiety, mood and pain management.
The drains are removed in the early postoperative period except for the one by the bile duct,
which is usually left for about a week or until the patient is on a regular diet and no bile leak is
detected.
4.3.2 EARLY COMPLICATIONS
The early complications after a liver transplant fall into four major categories.
The first includes surgical complications: which include intra-abdominal bleeding, vascular
thromboses and bile leaks or bile strictures. A bile leak is an occasional but serious
complication of transplant operations. Patients typically have abdominal pain, ongoing jaundice
and sepsis. Diagnosis may be made by HIDA scan or cholangiogram. Sometimes patients can
be managed by the placement of a stent at the time of an ERCP. Patients may require reoperation
for bile duct reconstruction.
The second category is primary non-function: which is another complication that the liver
itself may not work adequately postoperatively. This is termed primary non-function and may
be due to multiple factors, both patient and graft. Complete primary non-function is life
threatening and occurs in only 2% of transplants. The only option is retransplantation on an
urgent basis.
The third category is infection: Bacterial, fungal or viral. These are treated with appropriate
antimicrobial agents (See Appendix I & J for treatment guidelines).
Chapter 4 – Clinical Guidelines for Liver Transplantation – July, 2010 Page 12
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